Floor Statements

Before my colleague leaves the floor, I wish to ask him a question or two if he wouldn't mind. He has been involved in most of the major health issues that have passed this body in the last 15 years. What was the vote margin in the Senate on some of those bills, on the Hatch-Kennedy, Hatch-Waxman bills? How many votes, roughly? I am not asking you to pull that up from memory, and it may not be fair to do. As I recall, a number of people on both sides of the aisle ended up supporting those bills.

In the Finance Committee?

And Hatch-Waxman? It is longer back.

I believe you did a major health care bill with Senator Dodd from Connecticut.

Do you recall the split?

If I could respond to my colleague, I do not know of any. I don't know of any who were even asked. I know of some who were told you can join this bill, or asked that--OK, can you join our bill but you don't have any input.

None. I know of none.

I haven't seen any at all, and particularly when we tried to work in a bipartisan fashion to add Hyde language into the bill that was defeated, not accepted.

My point is something I have seen the Senator say in a quote, that a good health care bill should have 70 votes because it is major legislation that affects everybody in the United States. It has huge costs associated with it. So it is not something you do on a single- party basis, it is something you work extensively on over a long period of time.

I ask my colleague again, over how many years he worked with Senator Kennedy on getting the Hatch-Kennedy bill, or Waxman--my guess is those are lengthy pieces of negotiations that take a period of time to get something that has bipartisan support.

If I could ask one more question before my colleague leaves--and also a comment that I like the Senator's tie, nice bright colors on a Saturday session.

What does the Senator think of getting--how many total votes could you get for a bipartisan health care bill along the lines of which a number of people on our side have discussed, where you expand access, you try to bend the cost curve down, you try to get more access to low-income individuals? Does the Senator think he could craft a bipartisan bill that could get well over 60 votes on health care reform?

I said I would only ask the Senator one more question, but I have one more. My question is you didn't do those bills on the fly where you were amending them, saying

OK, we can't quite find 60, let's go back to a closed room and let's rebuild the bill. You built them over a long period of time. You did a good job of working the problems out together, and then you built it as it went along. You didn't say OK, let's do it on the fly, let's change this, let's change that. You build a solid piece of legislation and move it forward, not changing it at the 11th hour as we are seeing take place now.

I thank my colleague from Utah for that explanation and also for the years of service he has given, and particularly a lot of focus on health care issues. I haven't always agreed with my colleague from Utah. I have always found him, though, very sound in his thinking, very knowledgeable in his ways, in knowing how you do this, and particularly when you are talking about health care these are bipartisan issues in and of themselves and they need to be in this body.

He also talked about the principles of federalism, which I think we have deviated from in what we see from this bill. I wish to read from the Constitution, article I, section 8. That is the piece I wish to focus on here for a minute about the constitutional question involved in this health care bill. Article I, section 8 reads simply this way, that the Congress shall have--and then it lists a series of enumerated powers: power to ``regulate Commerce with foreign Nations, and among the several States, and with the Indian tribes.''

That is our ability to regulate commerce, with the foreign nations, among the several States, and with the Indian tribes. There are a number of people raising the question about whether you can constitutionally require everybody in the United States, by virtue of their citizenship or status in the United States, to have health insurance. I think it is highly questionable.

It appears to me from several legal scholars that this is unconstitutional for us to do. It is a major plank in the health care legislation that has been brought forward by the Democratic majority and I do not believe it is going to stand constitutional challenge. I want to develop that for my colleagues here today.

The Congressional Budget Office said this about the constitutional question here. They said forcing individuals to buy insurance would be `` . . . an unprecedented form of federal action.'' Those are big words in a time when we are seeing a lot of what I think are unprecedented Federal actions. Then going on to say, ``The Government has never required people to buy any good or service as a condition of lawful residence in the United States.''

You would be requiring, as a condition for lawful residence in the United States, the purchasing of a good or a service--in this case health insurance. As laudable as some people may look at that or say that is, that would be what is being required. The Congressional Budget Office does not know of any time where a person in the United States has been required to buy any good or service as a condition simply of lawful residence in the United States. I think it raises significant constitutional questions.

You have to remember, as everybody does, but I think we have to remind ourselves because too often we act as if we don't remember that the Federal Government is a constitutional government of limited powers.

From James Madison in the Federalist Papers, quoted often but it bears repeating because it is a foundational issue:

[I]n the first place it is to be remembered that the

general government is not to be charged with the whole power

of making and administering laws. Its jurisdiction is limited

to certain enumerated objects.

Which is what I just read from in article I, section 8.

Chief Justice John Marshall, in the famous Marbury v. Madison case, stated:

The powers of the legislature are defined and limited; and

that those limits may not be mistaken or forgotten, the

Constitution is written.

We can't violate that. The Federal Government is limited to enumerated powers granted by the Constitution. The Founding Fathers who drafted and ratified the Constitution were unwavering in their desire to restrict the powers of States and limit the powers of Congress. To achieve their goal they created a system that splits State and Federal authority so that one government, Federal or State, does not maintain too much power over the liberty of the American people. Therefore, the Framers created a system with a legislature of limited and enumerated powers, the Congress, to enact laws which shall be necessary and proper for the execution of powers. One of those is the commerce clause I just read which grants Congress the authority to regulate commerce with foreign nations, among the several States, interstate commerce, and with Indian tribes.

Many have used the commerce clause to justify the implementation of this unconstitutional mandate. Those individuals often cite the case of Wicker v. Filburn, a 1942 case. The U.S. Supreme Court decision found that a law prohibiting a commercial farmer growing an additional acre of wheat to feed chickens beyond the limits imposed on wheat production mandated by the Federal Government was constitutional and fell under the enumerated powers granted by the commerce clause. Filburn was ordered to destroy his crops and pay a fine to the government for being too productive.

The Supreme Court, interpreting the Constitution's commerce clause, decided that Filburn's wheat growing activities reduced the amount of wheat he would buy for chicken feed on the open market and affected interstate commerce and, thus, could be regulated by the Federal Government. However, that Supreme Court decision, agree with it or not, still does not expand the

powers of this body under the commerce clause to impose a monetary fine or penalty upon a citizen who fails to purchase or enter into a private contract for health insurance. That doesn't expand our authority under the commerce clause. It doesn't change the commerce clause. For us to require somebody to do something simply as a status of citizenship, the Congressional Research Service says:

Despite the breadth of powers exercised under the Commerce

Clause, it is unclear whether the clause would provide a

solid constitutional foundation for legislation containing a

requirement to have health insurance. Whether such a

requirement would be constitutional under the Commerce Clause

is perhaps the most challenging question posed by such a

proposal, as it is a novel issue whether Congress may use

this clause to require an individual to purchase a good or a

service.

To think that the Federal Government can compel any individual to purchase a commodity because that individual is alive and breathing is unconstitutional and is at least a novel issue that this $2.5 trillion proposal is built around. Should we be doing this major change in health care, $2.5 trillion in spending, \1/2\ trillion in reduction in Medicare, \1/2\ trillion raising in taxes off of a novel constitutional question involved in the inherent piece of it, that being the requirement for everybody to have health insurance? I think not. Along with all the other problems with it, I think it has an enormous constitutional question right in the middle of it. And what if you pull that out and the Supreme Court says, ultimately, you can't require that. Then you have done $2.5 trillion, $\1/2\ trillion in Medicare cuts, $\1/2\ trillion in tax increases, and your core piece is pulled out; it is unconstitutional. Then the whole house of cards falls apart.

Another popular argument for forcing citizens to purchase health insurance under penalty of law is that States require people to buy car insurance. This argument is not only constitutionally flawed but also an underwhelming argument that in many respects hardly deserves comment and adds little to the debate. It is recognized that States maintain inherent police powers to regulate behavior and enforce order within their borders to promote public welfare, security, health, and safety. This is a fundamental difference between the power of States and the enumerated powers of the national government, such as commerce between States and Indian tribes. This is a much broader granting of jurisdiction to the States.

State vehicle insurance laws are exactly that, laws implemented by States, and are generally derived from State constitutions and not the Federal Constitution under which this body operates. Furthermore, these laws require an individual who voluntarily participates in the use of an automobile to insure that vehicle. It is not a right of citizenship as a Kansan that you have to buy auto insurance. But if you want to operate a car on our roads, you have to have auto insurance. It isn't a requirement of citizenship.

We are requiring this as an article of citizenship. You have to have health insurance, a novel and enormously expansive role of the Federal Government.

The Federal mandate for the purchase of health insurance forces individuals to purchase a commodity not because they choose to participate in an economic or commercial activity such as what one would think would be covered under the commerce clause but forces an individual to purchase a product simply because that person exists. This mandate is an abuse of the power granted to this Congress by the Constitution.

Last night I spent some time developing another thought that I think is an important one for us to consider. It is one this body has spent some time over the last decade dealing with; that is, the removal of the marriage penalty from our Tax Code, which we haven't gotten very far in doing, but getting the marriage penalty out, the thought being that marriage is a good institution. It is a fabulous institution for the formation of family. It is something that has an enormous role in our culture and society and should be rewarded and should not be taxed.

The fundamental principle exists, if you want less of something, tax it; if you want more of something, subsidize it. In the Democratic health care bill there are marriage penalties on both low-income and upper income individuals that will reduce the incidence of marriage in this society, under the principle that if you are going to tax something, you will get less of it.

This bill has marriage penalty taxes in it. I want to go through a series of these, starting with the high cost plan tax, the Cadillac insurance plan. Married couples under this bill are hit hardest by the high cost plans tax. The number of single and married tax filers is equal, but married taxpayers pay more than twice as much as singles as a percent of new tax revenue in this bill.

So if you are married filing jointly, you will pay 62 percent--single filers, 25 percent--in this bill. Is that something we want to do? Do we want to say, if you are married, you will pay more of the tax? Most people would say: We want to encourage marriage and the formation of family around marriage. We should have these at least equal or maybe do a higher tax on the other end. But most would say let's have these be equal.

Instead, in this we have a huge increase in the amount of money married filers will have to pay as compared to taxes paid by single filers. Consequently, you encourage people to say: Let's not get married because we don't want to pay the increase in taxes.

The high cost plans tax, the Cadillac plans tax, will hit married couples' households far more severely than single filers. Even though the number of married filers and single filers is roughly equal, the high cost plans tax will impact the total tax bill of married couples much more severely: 25 percent of the revenue will be from single filers, 62 percent of the bill will go to married filers. One thing is certain, 62 percent of married couples' households don't make more than $250,000. So not only is this unfair to married households, it is a direct contradiction of the President's promise that you wouldn't pay more taxes if you were making below $250,000. In this case you do under the Cadillac insurance plan proposal or piece in this proposal.

I want to look at another chart on this subject. If we wanted to talk about factors that impact an individual's decision to enter the workforce or to invest in a business, an important factor is the marginal tax rate they will face on the next dollar they earn. Basically, it is a question of whether it is worth the effort and risk to work. What is my marginal tax? If I work longer and make another $100, how much do I get to keep? The marginal tax rate.

This is an especially important factor for low-income households, people who don't have much marginal income to work off of. They need every dollar they can get. So if you are going to tax their marginal rate, they are looking at this saying: I don't want to get in that category. I need to hold back from getting in that category.

We have tried to help the less economically fortunate with various types of support programs: TANF, food stamps, the earned-income tax credit, the additional child tax credit, to name a few. Low-income families already face high marginal tax rates as a result of the phaseout of their benefits and tax rates that mean the loss of benefits they get under TANF, food stamps, the earned-income tax credit, housing assistance, the welfare package we put together for low-income individuals. Low-income families already face high marginal tax rates as a result of the phaseout of their benefits. These phaseouts already impose significant barriers to marriage.

In other words, whenever you get a combined income of a low-income couple, you lose more benefits. Consequently, people don't get married because they look and say: I will lose my health benefits if I get married. I will lose my medical benefits, my housing benefits. I may lose food stamps. I will not get married.

Yet you look at the chances for children in that situation to get out of poverty, their best chance is to have a stable mom and dad and a stable marriage environment, providing for the comfort and support of those children. Our incentives are disincentives toward marriage in this way, and they are built even more significantly into this health care bill.

As an example, let's take two individuals at 150 percent of the poverty level. After the new subsidies proposed

in this legislation are taken into account, these two individuals would pay $1,478 for their health insurance. But if they get married, their bill will increase to $2,308, a marriage penalty of $830, if you are at the 150 percent of poverty level or below. If you are at 150 percent of poverty or below, you don't have marginal income to mess around with. You need everything you have just to provide the basics. So if you are looking at this increase in the marriage penalty of $830, you are saying: We can't afford to get married.

Is that the signal we want to send from the Federal Government? No. Everybody in this body would say that.

Let's take a pair of individuals earning 250 percent of the poverty level. One has no children; the other has two children. Unmarried they will, after subsidies, pay $5,865 for their health coverage. If they decide to marry, they will face a penalty of $2,050.

Let's turn to the new Medicare tax that will go into effect in 2013. The tax will apply to wage and salary income as well as certain business income for individuals. The tax will apply to income of that type for above $200,000 for individuals and $250,000 for joint filers.

The penalty is obvious on its face. Let's take an example. Two unmarried individuals earn $200,000 each, and their total Medicare taxes would be $11,600. But if they get married, the penalty is $750. Or take two individuals, one making $150,000 and the other $200,000. Single, their Medicare taxes total $10,150; if they get married, they will pay an additional $500. This is on top of the marriage penalties that two earners face under current law. The marriage penalty is there. I don't think it is as significant as for the low-income individuals, but it is here as well.

My point is, why on Earth would that even be built into the base of the bill, particularly on the low-income couples? Why on Earth would you build in a marriage penalty on people who can't afford it? If combined income is over $250,000, you can afford another $500. I am willing to agree with that. But not this couple that is making at 150 percent of poverty or 250 percent of poverty, one with two kids. They can't afford that. Why on Earth would you build it into this? This is ridiculous that it be placed in the proposal. It makes no sense.

Creating and expanding on the penalties for marriage makes zero sense. Families are a critical determinant of the well-being of our society. Family structure also has a significant impact on economic well-being, on education, and the effect on the social fabric of this Nation is positive.

It is a fundamental law of economics that when you tax something, you get less of it. Why would we tax marriage, particularly for low-income individuals, when it is the best chance for those children involved with this couple to have a stable environment, if they will form a solid marriage unit? And we are going to tax it and discourage it. That is wrong. That is wrong as a policy matter.

There is a number of other problems I have had with this overall bill. This piece of it absolutely makes no sense to me, why we would do something like this. I urge my colleagues to vote against this bill, to take these sorts of things out, to take them out of the base law. Unfortunately, in the United States today, this is kind of repeating what already takes place in food stamps, what takes place in health benefits for low-income individuals right now. They cannot afford to get married or they lose their benefits. It is ridiculous. We ought to give people bonuses for getting married, not penalties for getting married. Now we are going to add to it by putting it in this health insurance bill. It is wrong and it is bad policy.

Mr. President, I yield the floor.

Mr. President, I am delighted to follow my colleague from Utah. I am pleased he has raised these constitutional issues, which I think are significant to this bill. The idea that we could have a constitutional mandate to buy health insurance, to me, is highly questionable under our rights under the role of the Federal Government and under the Constitution. Senator Hatch has been on the Judiciary Committee for many years and he understands these issues very well.

We are now on our sixth iteration of the health care reform bill. This one talks about expanding Medicare, basically as one of the key components of solving the problem. Here is a quote from the Mayo Clinic I found, and others have also been cited. I found this interesting, succinct, and accurate:

Any plan to expand Medicare, which is the Government's

largest public plan, beyond its current scope does not solve

the Nation's health care crisis, but compounds it. It is also

clear that an expansion of the price control of the Medicare

payment system will not control overall Medicare spending or

curb costs. This scenario follows the typical pattern for

price control, reduced access, compromised quality, and

increasing costs anyway. We need to address these problems,

not perpetuate them through health reform legislation.

That was the Mayo Clinic. It is clearly not the way to go to solve the crisis or the problems. It probably hastens the day Medicare goes bankrupt, which is set to happen in 2017, 7 years away.

I want to talk about the possibility that this health care bill puts this very early piece of economic recovery that we are having at risk. The latest reports on unemployment provide some hope that our battered economy may be showing some tentative signs of economic recovery, as the job loss continues to slow. Most of this is based off of monetary policy. We are seeing some of this taking place.

Consumer confidence is still low. Unemployment hovers at 10 percent, and over 7 million jobs were lost since the beginning of the recession.

It should be clear that any potential recovery is incredibly fragile. That being the case, Congress and the administration should focus like a laser beam on policies that encourage economic growth and put Americans back to work. That seems to be obvious.

Instead, though, the administration and the Democratic-controlled Congress have taken up crucial months with a proposed revamping of our entire health care system that will cost nearly $2.5 trillion over the next 10 years, to be paid for by new taxes and employer mandates, and it will impose a grave risk to a sustained rebound of our Nation's economy. This hurts our economic recovery.

Not only that, but the Democratic health care bill includes some positively perverse incentives that would discourage hiring, work, saving, and even marriage. Again, it would discourage hiring, work, savings, and marriage. Higher taxes, more employer mandates, and disincentives to job creation, productivity, and family formation are hardly the prescription for the growth our economy so desperately needs right now.

Both the House and the Senate bills would, for instance, increase the already existing penalty on work faced by many low-income families who receive tax and in-kind benefits from government welfare programs. We already heard this. Health insurance subsidies in the legislation for individuals and families in poverty would tack on an additional 12 to 20 percent to marginal tax rates, which already approach 40 to 50 percent for families receiving a variety of benefits for those with low incomes. This would result in marginal tax rates of 50 to 60 percent for most affected families.

If working more hours or obtaining better paying jobs results in more than half of those additional earnings being taken away as a result of taxes or a reduction in benefits--if you are a low-income individual, you are working more, you are getting more money coming in, but your benefits from the government are reduced. So if you are taking 50 to 60 percent away in a reduction of benefits or in taxes, the incentive to work harder or to invest in an education is greatly reduced. That is obvious on its face. Yet it is in this bill.

This is not the only work disincentive in the bill. It is common for teenagers and college students to obtain jobs so they can have some spending money on their own or to help with their educational expenses. The Senate bill penalizes the families of these younger workers by including their wages in benefit eligibility calculations. For many low-to-moderate income families, the inclusion of their wages could mean a significant increase in their cost of health insurance or even in them losing thousands of dollars of health insurance subsidies altogether. That is in the bill.

And more harmful to the economy, potentially, are the incentives directed at employers. Both the House and Senate bills include temporary subsidies to small businesses to encourage them to offer employer-sponsored health insurance. As the number of employees increase or as salaries increase, the amount of the credit provided to the business decreases. The structure of this subsidy not only discourages employers from hiring new employees, but it also discourages them from increasing employees' salaries. We don't want those sorts of disincentives in any bill.

Ironically, the incentives in the bill would even work to encourage employers to drop health insurance coverage for individual employees or eliminate insurance coverage altogether. The Senate bill would cap employee contributions to insurance premiums at 9.8 percent of their income. If an employer

offered a policy that required employees to pay more than this, the employee would be eligible to purchase insurance through the new ``health care exchanges.'' The employer would have to pay a fine. Since, in many cases, that fine is considerably less than the additional insurance costs the employer would incur if they retained coverage, many businesses concerned about the bottom line would be enticed by the bill to stop providing any health insurance coverage. So they are actually enticed here to drop health insurance coverage-- another thing we don't want to see happen.

Furthermore, employers who offer flexible spending accounts or FSAs will be encouraged to stop providing these tax-free medical spending accounts for their employees. Under the Senate Democrats' bill, FSA contributions will be included in the total cost of employees' health insurance benefits for the purpose of calculating the proposed tax on high-cost health plans--the so-called Cadillac health care plans. Adding an FSA contribution could push the total cost of health benefits above the high-cost threshold for many workers, which will result in the employer being liable for a portion of the 40 percent high-cost plan's tax. As more and more plans become subject to the high-cost plan's tax, it will be in the employer's best interest to eliminate FSA offerings altogether. That is another disincentive we don't want to see happening.

The proposed legislation would also create new marriage penalties across the income spectrum. We have been working for some years to do away with the marriage penalty. Marriage is a good and solid institution that helps so much in this Nation. Yet it puts in a marriage penalty, penalizes people for getting married; it is built into this legislation. These penalties can be so large that, in some cases, couples would have to forgo marriage in order to avoid thousands of dollars in new taxes. The penalties are significant. Low- and moderate-income families often have limited savings as well. Given the already significant marriage penalties in low-income benefit programs, it seems ironic that the government would create yet another program that penalizes low-income individuals for getting married.

Currently, if they are on public assistance and they get married, their combined incomes often move a couple out of the support they receive for their families, whether it is health support, housing, or food support. By getting married, they often lose their benefits. Instead of taking them away, we ought to be helping them form solid families. That sort of disincentive is built into this health insurance plan as well, where you actually put in disincentives for low-income couples to get married. In other words, to be able to get the health insurance subsidy, they may have to forgo marriage. That is not the sort of incentive we want in the system and in the bill. We are trying to take it away in the welfare programs, but to add another piece to low and moderate-income couples is the wrong way for us to go.

That the Democratic health care legislation would set the United States on a path to a single-payer government-run health insurance system of the sort found in Europe and Canada is bad enough, but even more troubling is the fact that these proposals would create a series of perverse incentives ultimately harmful to workers, businesses, and the entire economy. The Senate must reject this poorly conceived, ruinously expensive scheme and get back to the business of helping our economy recover.

I have talked to many people across the United States and particularly in Kansas, many people who are deeply concerned about this economy and the perverse things coming out of Washington. While they might start considering investing in their small business, putting some income or something out to be able to grow and create jobs, people are holding back and saying: I don't know how many more taxes you will put on us or what the health insurance plan will look like. I don't know what cap and trade will do on raising energy costs.

They are holding back. These perverse economic signals, and the discussion of them in Washington, is perversely affecting the economy. It is hurting the economic recovery. If you put these pieces into place statutorily, you are hurting savings, hurting hiring, hurting marriage formation, and you will further hurt an already very tentative recovery from taking place.

This is a bad medicine for the economy. The idea that you would expand Medicare to take care of that is a terrible idea. You will be hurting a program that already is not financially solvent in the long term and is looking at something like $30 trillion of unfunded obligations already on its books. That alone, if you expand it back to age 55, plus the provider community--the American Medical Association and the American Hospital Association are opposed to this expansion of Medicare. They don't get full reimbursement of costs right now. With the talk about bringing it back to age 55, you will be sweeping a large number of people into Medicare, so you are sweeping in a lot of people who are already in private insurance plans. When they are pulled out of private insurance which pays at the full rate to the provider community, you are taking those resources away from the provider community, from doctors and hospitals. That is why you are seeing the American Medical Association and the American Hospital Association come out against this proposal on Medicare expansion. How on Earth would it ever be paid for, when the program is already not on a stable financial track?

The Federation of American Hospitals stated this:

The FAH is strongly opposed to this proposal. A Medicare

buy-in would involve Medicare rates, would be controlled by

CMS, and would crowd out older workers with private coverage

and may choose early retirement as a result. Such a policy

will further negatively impact hospitals.

In my rural State, in particular, it would have a huge negative impact on a number of the hospitals in my State.

Mr. President, I yield the floor.

How much time do I have allotted? I thought there was an agreement that I had a certain amount of time.

I yield myself 10 minutes to speak on the Dorgan amendment.

Mr. President, the Senator from North Dakota is a strong, good, talented legislator. He has a good amendment, one I have looked at. It has been around for a long time. I have to rise in opposition to it.

I am ranking member on the Appropriations Subcommittee on Agriculture, Rural Development, and the Food and Drug Administration. The FDA is in the purview of our subcommittee, so I work on the issues of the FDA. If I may brag, the University of Kansas is one of the best pharmaceutical schools in the world and is often rated No. 1 as a pharmacy school. For anybody interested in that field of study or work, it is a good place to go. They are very concerned about what is in the Dorgan amendment.

The United States currently has one of the safest drug supply systems in the world that allows the Federal Food and Drug Administration to monitor and regulate the manufacture and distribution of approved medicines. The legal authority to import drugs already exists in this country. However, no HHS Secretary, Democrat or Republican, has been able to certify that the importation of prescription drugs from foreign nations is safe or will lead to cost savings. None have been able to.

The Dorgan amendment will allow for the importation of drugs from outside our current regulatory system, established and enforced by the FDA without certification from the Secretary of HHS or the Food and Drug Administration. Allowing drug importation from foreign nations could threaten public health and result in unsafe, unapproved, and counterfeit drugs being placed on pharmacy shelves in the United States.

I want to develop that thought. The FDA has been tasked with the responsibility of safeguarding this country's prescription drug supply and has executed that responsibility quite well. But as this country and the Food and Drug Administration struggle to prevent the growing threat posed by imported, foreign-produced goods, as evidenced by recent failures to detect polluted products such as infant formula, pet food, and toothpaste, permitting the importation of drugs from foreign nations without the complete assurance from the FDA that it will not jeopardize public safety is irresponsible and threatens this Nation's safety and proven drug supply.

Toward that end, I ask unanimous consent that a letter that Senator Carper received from the Health and Human Services agency, the FDA Director, be printed in the Record at the conclusion of my comments.

This letter states in particular:

We commend the sponsors for their efforts to include

numerous protective measures in the bill that address the

inherent risks of importing foreign products and other safety

products relating to the distribution system of drugs within

the U.S. However, as currently written, the resulting

structure would be logistically challenging to implement and

resource intensive. In addition, there are significant safety

concerns related to allowing the importation of non-

bioequivalent products, and safety issues related to

confusion in distribution and labeling of foreign products

and the domestic product that remain to be fully addressed in

the amendment.

In other words, they don't think we can do this--importation, reimportation of drugs--without significant safety problems.

There has been an explosion of illegal drug counterfeiting occurring around the world. Emergence of a multibillion-dollar international black market has

proven to this Senate, current and past HHS Secretaries, and the FDA that weakening our prescription drug regulatory framework would only increase the risk of life-threatening counterfeit, contaminated, or diluted prescription drugs entering our prescription drug supply that millions of Americans rely on and trust. Prescription drug counterfeiting has become a highly profitable criminal enterprise that has been taken up by international organized crime syndicates, rogue nations such as North Korea, Syria and Iran, and developing nations such as China and Pakistan that seek to exploit ineffective or weak counterfeit enforcement frameworks around the globe.

Criminals have realized that the production of counterfeit drugs is twice as profitable as the trafficking of illegal narcotics and comes with significantly less criminal penalties compared to those handed out for illegal drugs.

Due to these limited and minimal criminal penalties, global counterfeiting has grown into an epidemic that reaches every country around the world. The World Health Organization estimates that tens of thousands of people are dying due to counterfeit HIV, diabetes, and tropical disease medicines. Unfortunately, in most counterfeit cases, it is not what is included in these fake drugs, it is what has been excluded that proves to be most harmful and deadly to patients. By taking counterfeit, diluted, or completely ineffective drugs, many patients fail to receive the important lifesaving medicines they need. It is just as dangerous for a person with high cholesterol to use a counterfeit drug that lacks the prescribed medicine as it is for a person to ingest a contaminated or even a poisonous pill. Due to this global counterfeit epidemic, two Secretaries of HHS, under both the Clinton and Bush administrations, have been unable to certify that the importation of prescription drugs will not pose a substantial risk to the health and safety of citizens within the United States.

Current Secretary Kathleen Sebelius, from Kansas, has committed to preventing a drug importation system in the United States until it can be proven that the safety standards of the imported drugs are ``at or above American standards.'' The FDA doesn't believe they can get that done at this time.

Many have argued that parallel trade in Europe has proven drug importation across nations' borders has resulted in prescription cost savings and has not increased risks to consumers or general public health. However, these cost and safety assertions do not correctly reflect the European experience with drug importation through what is called parallel trading.

A study by the London School of Economics on drug importation costs concluded that savings from parallel imports benefit middlemen and third-party vendors who buy and resell the imported drugs and do not get passed on to the patients in the form of lower prices. They say this:

Although the overall number of parallel imports has

continued to increase, healthcare stakeholders are

realizing few of the expected savings . . . profits from

parallel imports accrue mostly to the benefit of the

third-party companies that buy and resell these medicines.

Furthermore, a report by the University of London School of Pharmacy on the safety of the parallel prescription drug trade stated this:

The United Kingdom is the most vulnerable in Europe to

counterfeiting owing to the high level of ``parallel

importing.''

Due to parallel trade, the Medicines and Health Care Regulatory Agency in the UK has issued 10 different recalls of counterfeit drugs in the past 5 years. Drugs recalled include prescriptions to treat schizophrenia, blood pressure, and prostate cancer. The most disturbing fact of this counterfeit infiltration was that these drugs entered the United Kingdom through legitimate supply chains through parallel distribution trade, according to the MHRA, the regulator agency in the

Mr. President, I ask unanimous consent the order for the quorum call be rescinded.

Mr. President, I ask for 10 minutes to be allotted to me under the minority time.

Mr. President, in the past few months this body has been forced to stand aside as Senator Reid and a few others crafted a 2,000-page bill behind closed doors, the one we are on right now. Unfortunately, the product that was resolved at the closed-door meetings--at least the one we have now, I don't know about a future one--still raises taxes by $\1/2\ trillion. Probably under any new bill that comes out you are going to have taxes going up $\1/2\ trillion, cut Medicare by $\1/2\ trillion, raise premiums on American families, fail to bend the cost curve down, and expand government's encroachment further and further into people's health care decisions.

What I want to go through is a series of charts about how inflation is going to end up being the tax collector's best friend in this overall plan and how the tax of inflation is going to be one of the key features of how the overall bill is paid for.

I hope most people remember when we had inflation. A lot of people maybe don't remember when we had significant inflation. It is a cruel tax. It is a very cruel tax on people on fixed income, a very cruel tax on people in low-income status because constantly the dollars you have stay pretty stable, and everything you are buying goes up. So inflation kills you. It kills you in the pocketbook and is one of the things we have to be concerned about, particularly with the amount of money that is out in the money supply today and the likelihood of this moving forward and how it is built in to pay for this huge expansion that we can't afford in this bill.

I am joining my colleagues today in speaking against the $500 billion in new taxes that are in the Democrats' proposal to levy on the American people and the job-creating small businesses this is going to be put on, in an attempt to pay for this big 2,000-page bill.

This monstrous bill is flawed economic policy. I will develop that point for you as well. It fails to lower health care premiums, fails to bend the cost curve down, and will further cripple the struggling economy with massive and burdensome tax increases.

This careless legislation reminds me of a cautionary tale that is still being played out in another part of the world. That is what happened in the early 1990s in Japan. Japan, a surging economic giant at the time, suffered a severe economic recession in the early 1990s, of which the effects are still lingering even today in Japan.

During Japan's ``lost decade,'' from 1991 to 2003, their gross national product grew a paltry 1.4 percent annually, creating a decade of stagflation--that is where you have a stagnant overall growth but inflation in the economy--and limited economic growth. Most economists believe that Japan's economic recession would not have lasted nearly as long as it did had it not been for one fatal error that the Japanese government made. In the late 1990s, as their economy was recovering and appearing to be pulling out of its economic slump--so the economy is just getting going, starting to pull out of the economic slump--the Japanese government made a catastrophic decision to raise taxes. The result was that this one decision aborted the strong recovery the Japanese economy was starting to experience and plunged it back further into an economic downturn that lasted for many more years, the hangover from which is still on them today.

What are we doing here today, discussing a $2.5 trillion government entitlement expansion that raises taxes $\1/2\ trillion, plays budget gimmicks with our $12 trillion deficit and raises health premiums and costs for all Americans in the middle of the country's economic recession? What are we even talking about, why are we doing it? That is what I get from the people back home. They say why are you talking about this while are we in this recession? Why are you talking about this with the health care situation the way it is, to raise the cost, raise the insurance premiums, cutting Medicare when Medicare needs more, not money taken out of it? Now is not the time, this is not the bill, and this is not the way the American people want to see their health care reformed. What the American people want is for this body to lower health care costs and induce an economic recovery that creates jobs, not kills them, and grows the American economy, not thwarts it.

The way to do that is not to raise taxes, as is evidenced by what happened in Japan. Increased mandates, increased regulations, and increased taxes are a recipe for disaster. It is a recipe that kills jobs. In fact, President Obama's chief economic advisor, Dr. Christina Romer, stated earlier this year that as many as 5.5 million jobs could be lost due to the Democrats' new tax proposal in this 2000-page government takeover of health care. Nothing can be worse at a time when the Nation is already experiencing a 10-percent unemployment, a 26-year high. This bill will impose $28 billion in new taxes on employers that will ultimately be paid by American workers in the form of reduced wages and lost jobs.

Under this burdensome legislation employees will face stunted wages and the loss of their benefits as their employers attempt to find ways to fund these newly imposed mandates. As small businesses struggle to keep their doors open, tough decisions will have to be made on whether to raise prices, cut wages, or let go workers in order to find the funds necessary to comply with the Federal mandates imposed in this bill.

Furthermore, this bill will kill jobs by penalizing small businesses who are looking to grow--and small businesses are the growth engine for the country. In this bill, firms with more than 50 workers that did not offer coverage would have to pay a penalty or a tax to the Federal Government for each full-time worker if any of their workers obtain subsidized coverage through the government-run exchange.

What businessman would decide to hire that 50th employee, knowing full well if he did that the government would penalize his business and slam him with a new costly tax? So now people try to stay under this limit rather than constantly looking to grow the business.

Furthermore, under certain circumstances, firms with relatively few employees and relatively low average wages would be eligible for tax credits to cover portions of their health insurance premiums. That is relatively few would be eligible.

I ask, what employer would decide to increase the number of employees or increase the amount of their wages if they stand to lose government handouts, supports, subsidies, or face an increased tax burden? They simply will not be willing to do it.

One of the most disturbing aspects of this legislation is the use of inflation

to fund it--the use of inflation, a hidden tax increase on working families, to fund it.

I am the ranking member on the Joint Economic Committee and we look at these aspects a great deal. The use of inflation is built into the base of this to fund it. We know the consumer, the individual taxpayer, pays all taxes. No matter how the government claims to assess those taxes, they are paid by individuals.

I have a couple of examples I want to show. First, I want to talk about: High-cost Plans Tax Hits the Middle Class. Let me talk about that. This is the tax on the so-called Cadillac health insurance plans.

We know that insurance policies and benefit plans will be altered to avoid that tax. In other words, if you get an insurance plan that is up above a certain level you get taxed on that higher end, that so-called Cadillac plan. So in all probability most groups will not provide this high-quality health care because they say you are going to get taxed on it.

Benefits that taxpayers with insurance currently receive on a pretax basis--right now they get it so the company is paying for it, is pretax to the individual--will gradually shift to after-tax benefits resulting in higher payroll and income taxes. So now that you have cut this Cadillac plan to get underneath it being taxed, and then the company says OK, we will pay you in wages or we will do this somewhat differently. Then you have to go around and supplement or have a lower quality of health insurance. You are going to have to pay for it with after-tax dollars. That will result in more taxes, but you don't get more benefits from this. This is a big tax hit on the middle class of people who are going to have to pay this as their higher income or their higher based insurance plans are taxed.

Here is what the Joint Committee on Taxation said about the distribution impact of the high-cost tax plans: Despite the President's promises the majority claims--91 percent of taxpayers will be affected by this tax earning under $200,000. The tax will hit married filers more severely than singles; 62 percent of the high-cost plans tax impact will fall on married filers compared to 25 percent on single filers. Why are we building the marriage penalty back into the insurance? We worked a long time in this body to get rid of key portions of the marriage penalty, saying we should not tax marriage, we should support this institution. It is being built back into this plan.

This bill also imposes an additional Medicare tax on wage and salary--or certain types of business incomes of single taxpayers with incomes above $200,000 and married taxpayers with incomes of more than $250,000. Right off the bat there is a new marriage penalty. People living together but unmarried making $150,000 each won't pay the tax. Two married people paying the same amount will. What is right about that?

Making matters worse, the thresholds are not indexed for inflation-- no indexing for inflation. Inflation is a cruel tax and unfortunately in this situation it is not only going to be inflation, but you are going to be taxed, then, as you get inflated into these categories. From 2013 to 2019, the number of returns of people earning under $200,000 in today's dollars will rise from 75,000 to 345,000 under the current trajectory on inflation. We are making the tax man's best friend inflation. That is wrong. So you are going to move 75,000 to 345,000 for new tax revenue. Married couples will be hit hard, as I mentioned earlier. Then you are looking at inflation: 2013, 2015, 2017, 2019--the number of people growing into this taxable category affected by this Medicare tax that will increase in 2009 dollars from $75,000 to $345,000.

If you want to think about this, think about when the alternative minimum tax was first put in place. The alternative minimum tax was supposed to be on very wealthy individuals. That was all it was going to be on. But it was not indexed for inflation. Now you get whole swatches of people hit by it and this body regularly tries to change that or deal with it on a 1-year basis because it was not indexed for inflation. What you build into the base of this bill is, if you want to pay for the bill, you want inflation. So you get inflation and it hurts people on fixed incomes and you get more people taxed than you started off with. You didn't tell them about it at the outset.

This plan clearly should be indexed for inflation. We know that should take place. Yet this is where a major part of the money for the bill comes from--inflation. Is that something the Federal Government should be banking on, that we will get inflation to pay for this health care bill? I don't think the American public wants to see that taking place.

To put this in context, let's not just look at returns under $200,000, let's look at all returns and how this tax will spread. According to the Census Bureau estimates, between 2013 and 2019, the working-age population of the country will grow by 1.6 percent. Joint Tax estimates that the number of returns that will be affected by this tax will grow by 52.6 percent and revenue collected as a result of the tax will grow by more than 54 percent. Over time, the Reid bill Medicare tax isn't just for the wealthy. Comparing the increase in taxes with growth in the working-age population, this is how many more people will be impacted. Inflation becomes the tax man's key friend.

During Japan's lost decade, from 1991 to 2003, their gross national product grew a paltry 1.4 percent annually, creating a decade of stagflation and limited economic growth. It was because of policies such as this where you have inflation, where you have tax increases put in place. These are the things that caused that to take place. It should not be done.

I will just add as a final note, when I am talking with people back home, all the time they raise this health care bill. They talk about it constantly. If they are small businesspeople, they are talking about not doing anything until the political environment is more stable in their estimation, about how much taxes we are talking about, about how much regulation we will be talking about.

You have what is going on with a climate change debate and regulations in Copenhagen. That tells a lot of people in my area who are energy users and producers, don't do anything until this stabilizes. When you talk about tax increases or inflation being a part of this proposal, you have a bunch of people saying: Don't do anything. Just stay on the sideline. That is a prescription for no job growth. That is a prescription for killing jobs. You want people out there investing and creating jobs and opportunities. You want them to see a stable political environment where they are not worried about increasing taxes, not worried about increasing regulation but, rather, saying: This is a stable environment in which we can invest and grow. That is not what they are doing today. That is repeating the lesson the Japanese learned of raising taxes when you are coming out of a recession. It is harmful. It is the wrong economic strategy. It should not be a part of this bill.

I yield the floor.

Mr. President, I ask unanimous consent that the Senate proceed to a period of morning business, with Senators permitted to speak for up to 10 minutes each.

Mr. President, I rise to speak about the recent suicide bombing in Somalia and the broader security situation in that region. While our attention is necessarily focused on the wars in Afghanistan and Iraq, this latest bombing is a stark reminder that we cannot take our eye off of the Horn of Africa.

Last week, Somalis had a reason to celebrate. The graduation of several medical students from a university in Mogadishu was a welcome glimmer of hope for the future. Unfortunately, a suicide bomber intruded, blew himself up, and killed more than 20 others, including three Ministers from the fledgling Somali transitional government. There is, seemingly, no end to the violence which has plagued Somalia for a generation.

Somalia continues to lack a truly functional government, and for several years, we have watched the slow but steady development of extremism there. Though we support the development of a moderate government for Somalia, success is far from assured. The transitional government lacks control of significant parts of the country and struggles to provide the most basic services to the Somali people.

The most significant challenge to the transitional government comes from extremist groups such as al-Shabab, a group of Islamist terrorists with deep roots in Somalia that came to prominence after the defeat of the Islamic Courts Union 3 years ago. As we have seen throughout the world, if there is a power vacuum, violent extremists will seek to fill it, and that is what is taking place in Somalia. Somalia cannot succeed while groups such as al-Shabab grow and thrive.

Al-Shabab's future depends in no small part on support from outside the country. Al-Shabab gets new recruits from all over the world, it is strengthening ties to al-Qaida and the global jihadist network, it receives support from regional actors such as Eritrea, who use al- Shabab as a proxy for its own interests. Al-Shabab will not be defeated while this outside support continues.

For this reason, I hope that our administration will work hard to support and pass a draft resolution now circulating at the United Nations Security Council. Uganda, one of the Council's current rotating members, has drafted a resolution that addresses Eritrean support for Somali extremist groups, including al-Shabab. The resolution, which follows strong warnings to Eritrea from the U.S. and the African Union not to support al-Shabab, would ban weapon sales to Asmara, prohibit technical, financial and other assistance related to military activities, and freeze the assets of Eritrean political and military leaders as well as restrict their travel.

Al-Shabab seeks to undermine any attempt to stabilize Somalia. A volatile Somalia jeopardizes the stability of the Horn of Africa region, which is itself important to security in Africa, the greater Middle East, and the rest of the world. Support for extremist groups such as al-Shabab is unacceptable, and as long as Eritrea provides arms to al-Shabab, there will be no chance for peace in Somalia. I hope that the Security Council can take up and pass this resolution soon, and I hope the United States will be a strong supporter of this effort. Somalia ought not be a safe haven for extremists or a playground for outside powers pursuing their own agendas. Though Somalia's future is far from clear, the Security Council should have no difficulty in agreeing on the need to take steps to cut al-Shabab's lifelines of outside support.

Will the Senator yield for a comment?

In responding to the Senator from Pennsylvania as well, I wish to quote Bart Stupak, who carried the same sort of amendment you are putting forward, only on the House side. The same sorts of questions, naturally, were coming forward, saying: OK, you are blocking abortion funding for the individual. He said this--and I am quoting directly from Representative Stupak:

The Capps amendment--Which is in the base Reid bill here--

departed from Hyde in several important and troubling ways:

by mandating that at least one plan in the health insurance

exchange provide abortion coverage, by requiring a minimum $1

monthly charge for all covered individuals that would go

toward paying for abortions and by allowing individuals

receiving Federal affordability credits--

Those are Federal dollars--

to purchase health insurance plans that cover abortion. . . .

In all those ways, the Capps amendment--which is in the Reid bill-- expands and does allow Federal funding of abortion that we have not done for 33 years.

Going on with Representative Stupak's statement:

Hyde currently prohibits direct federal funding of

abortion. . . . The Stupak amendment--

Which is also the Nelson-Hatch amendment--

is a continuation of this policy--

Of the Hyde amendment--

nothing more, nothing less.

I think it is important to clarify that this is a continuation of what we have been doing for 33 years that the Senator from Utah and the Senator from Nebraska are putting forward with this amendment.

I thank my colleague for yielding.

Will my colleague yield?

If you are not clear about this, then abortion will be funded. If there is any of this that needs clarity one thing is for certain with the Capps language in the baseline of the Reid bill, that abortion will be funded.

The Commonwealth of Massachusetts recently passed its State-mandated insurance, Commonwealth Care, without an explicit exclusion on abortion. Guess what. Abortions there were also funded immediately. In fact, according to the Commonwealth Care Web site, abortion is considered covered as outpatient medical care. That is a point about being clear with the Hyde-type language, which is the Nelson-Hatch language, which says: No, we are not going to fund this, and we are going to continue the 33-year policy. If we keep the Capps language in that funds abortion--the last time the Federal Government funded abortions was during that 3-year period after Roe, but before Hyde, and we were funding about 300,000 abortions a year. The Federal taxpayer dollars funded abortions through Medicaid.

I cannot believe any of my colleagues would say: Yes, I would be willing to buy into that 300,000 abortions a year when President Obama and President Clinton said we want to make abortions safe, legal, and rare. Well, 300,000 a year would not be in that ballpark. That is the past number that happened when you didn't have Hyde language in place at the Federal level.

Madam President, I think the Catholic bishops have put it as concisely as anybody:

In every major Federal program where Federal funds combine

with nonfederal funds (e.g. state or private) to support or

purchase health coverage, Congress has consistently sought to

ensure that the entire package of benefits excludes elective

abortion. For example, the Hyde amendment governing Medicaid

prevents the funding of such abortions not only using federal

funds themselves, but also using the state matching funds

that combine with the federal funds to subsidize the

coverage. A similar amendment excludes elective abortions

from all plans offered under the Federal Employees Health

Benefits Program, where private premiums are supplemented by

a federal subsidy. Where relevant, such provisions also

specify that federal funds may not be used to help pay for

administrative expenses of a benefits package that included

abortions. Under this policy, those wishing to use state or

private funds to purchase abortion coverage must do so

completely separately from the plan that is purchased in

whole or in part with federal financial assistance. This is

the policy that health care reform legislation must follow if

it is to comply with the legal status quo on federal funding

of abortion coverage. All of the five health care reform

bills approved by committee in the 111th Congress violate

this policy.

Following the Hyde amendment principles is what we have done for 33 years, until this moment, until the Capps language in the Reid bill. Now we have flipped that on its head and are saying you can combine Federal funds with non-Federal funds to pay for elective abortions. That was the policy prior to Hyde in 1977. That funded 300,000 abortions, roughly, a year at that point in time. There is no way in this country that is a policy the American people support. They don't. They may be divided about abortion but not about Federal funding for elective abortion. There is no division about that at all. It has been very consistent policy, until we have seen the Reid bill, this particular piece of legislation. We have been quite consistent about this. It is my hope my colleagues will say: I may be pro-choice, but I have consistently supported Hyde because I think we should not be funding elective abortions.

I hope they will vote for the Nelson-Hatch amendment because of that very feature. It is not about abortion, it is about the funding of elective abortions. I hope we don't go in that direction.

I yield the floor.

Mr. President, I appreciate this very much. It has been a healthy debate, a big debate, and it is an unusual debate because we haven't debated Hyde around here for 20 years. So this is an unusual debate we are having. Normally, we debate about abortion but not about abortion funding because there has been an agreement in this body for 33 years about that. So this is an unusual debate, but I think it is an important one.

I think it is extraneous, in many respects, to the health care bill itself. Abortion is not health care, and so why we are debating the funding of abortion in a health care bill seems odd to me. But it is in the base bill, and we need to deal with that.

A lot of people are coming forward and saying: Well, OK, which way is this; is it in the bill or not on funding for abortion? I am going to go to an independent fact checker and cite this. This is an independent research and prize-winning fact checker, PolitiFact.com, and they say our opponents' characterization of this amendment was ``misleading'' and that ``the people who would truly pay all their premium with their own money, and who would not use Federal subsidies at all, not barred in any way from obtaining abortion coverage, even if they obtain their insurance from the federally administered health exchange.''

That is an independent group, PolitiFact.com, saying this doesn't limit the ability for somebody on their own to be able to purchase abortion coverage, if they want to do that, but in the base bill, what we are saying is we don't want to put Federal funds in it as the longstanding policy has been here.

As the President himself has said when he spoke to a joint session of Congress, launching the health care debate:

One more misunderstanding I want to clear up--under our

plan, no Federal dollars will be used to fund abortions, and

Federal conscience laws will remain in place.

Unfortunately, in the Reid bill, this is not true. This is not true in the Reid bill. What is in the Reid bill is the so-called Capps amendment language, which allows for the Federal funding of abortion.

I wish to describe--and I think a great deal of what is in here has been described, but what is taking place is the Federal subsidization of an insurance program that will have abortion funding in it. According to most groups, that is what is taking place in the Capps language, which is in the base Reid bill.

I say this is an unusual debate that is taking place because we haven't debated Hyde for years around here. I wish to read to you what is our normal status on funding of abortions; that is, that we don't do Federal funding of abortions. I will read to you what the normal status is. The U.S. Conference of Catholic Bishops, which supports this base bill but does not support funding of abortions, describes it this way:

In every major federal program where federal funds combined

with nonfederal funds to support or purchase health coverage,

Congress has consistently sought to ensure that the entire

package of benefits excludes elective abortions. For example,

the Hyde amendment governing Medicaid prevents the funding of

such abortions not only using federal funds themselves, but

also using the state matching funds that combine with the

federal funds to subsidize the coverage. A similar amendment

excludes elective abortions from all plans offered under the

Federal Employees Health Benefits Program, where private

premiums are supplemented by a federal subsidy.

So there it is prohibited as well.

Where relevant, such provisions also specify that federal

funds may not be used to help pay the administrative expenses

of a benefits package that includes abortions. Under this

policy, those wishing to use state or private funds to

purchase abortion coverage must do so completely separately

from the plan that is purchased in whole or in part with

federal financial assistance.

Here I take a quick aside. That is what we are saying should be done in this bill, but it is not what is done in this bill.

Going on:

This is the policy that health care reform legislation must

follow if it is to comply with the legal status quo on

federal funding of abortion coverage. All of the five health

care reform bills approved in the 111th Congress violate this

policy.

This is from a group, the United States Conference of Catholic Bishops, that supports health care reform but not the abortion funding in it. They say as well that this fails in the Reid bill, that there is explicit funding for abortion in this bill.

I thank my colleagues, particularly on the other side of the aisle, Senators Nelson and Casey, for being major cosponsors of this amendment. They are the ones who look at this and say: I don't want this in the base bill. This should not be in the base bill. It doesn't belong in the base bill. The language should be different.

I also wish to note that most people across the country don't want this in the base bill. A majority of the country is opposed to the bill overall. They don't think this is the way we should go. They think it is the wrong way. But even people who support the bill itself by and large don't want Federal funding for abortion to be in this bill.

A Pew poll even showed that 46 percent of people who support health care reform want to see the radical abortion language removed, the Capps language in the Reid bill, and all pro-choice Republicans and several pro-choice Democrats supported the measure in the House that put Stupak language in that removed the Federal funding for abortion. The American people feel this way because they know that forcing Federal funding of abortion is fiscally irresponsible and morally indefensible. Those are the two central pieces we are discussing, the fiscal responsibility or irresponsibility of this and the moral indefensibility. At a time of hemorrhaging debt, the Federal Government being supportive and funding elective abortions flies in the face of trying to restrain or bend the cost curve down in this legislation. That is not us being fiscally responsible.

I have shown this chart before, but I think it is so striking. Back when we did do funding for abortions, we funded about 300,000 a year. How is that extra funding going to help us be more fiscally responsible? That is why a majority of the people, pro-life and pro- choice, are saying the Federal Government should not be funding this. I don't believe that is fiscally responsible. And it is morally indefensible.

Whether you are pro-choice or pro-life, we are having 300,000 children who are not going to be here that we are funding the elimination of. Under anybody's definition of looking at that, they would say that is morally indefensible for the Federal Government that has long debated abortion policy, has not debated abortion funding, that that is morally indefensible for us to do something along that line.

There are many issues to debate but thankfully Hyde has not been one of them we have been debating until now. I say to my colleagues the admonition we have had many times, whether you choose this day life or death, blessing or curse, why wouldn't we choose the life route on this one? Even if you have a close call or you are questioning this, why wouldn't we choose the route that says: I am not going to fund 300,000 abortions. I want abortion to be safe, legal and rare, as some people in this body, but that is not rare, 300,000. Why wouldn't we choose the life route that says this is a controversial issue sometime way in the past, not recently. We don't fund these things. So many people in America don't want their money used to pay for abortions. Yet in this base Reid bill, it is there. I urge my colleagues to vote in favor of the Nelson-Hatch-Casey amendment that puts into Hyde language that is the status quo that there is not taxpayer funding going toward abortion and to reject those who would put the Reid language forward that would take us back decades to an era when we did fund abortion procedures.

I yield the floor.

I appreciate that. I also note the Ensign amendment, instead of cutting, creates.

A Robert Woods study in 2006 said caps on things such as this hold down awards in cases 20 to 30 percent and increases the supply of physicians, which is something else we need.

I wish to give a better live example that we have in my State of Kansas. In the early 1980s, mid-1980s the piston engine industry of aircraft was just about dead. It had been sued--the aircraft industry, general aviation had been sued so much they were stopping making piston engine aircraft. Congress, finally, because the industry was dead, said we are going to put a 17-year statute of limitations on it so after 17 years you cannot sue the manufacturer anymore after that period of time.

It brought the industry back. They are now being made. There is a new plant in Independence, KS. There is another one that is making this aircraft because there was a limitation put, a reasonable limitation on manufacturing reform.

If we do this, this will create--this will help our medical industry, it will hold down costs, it will increase the number of physicians. These sorts of changes have worked. There is no reason at all not to do this in this bill.

Madam President, I wish to thank the ranking member from Iowa for his comments on the amendment.

I wish to speak on the Johanns motion and its effect on the State of Kansas and the underlying bill in particular. Cuts to home health agencies of $42 billion have a huge impact in my State, and I wish to urge my colleagues to support the Johanns amendment and restore that amount of money to the home health care agencies.

Years ago I did some work with the home health care agencies, and anybody who has been around them knows these groups don't operate on much of a profit margin. They are frequently not highly capitalized. They are high on people and people skills. They take care of folks in their homes. They do a great job of it. They take care of people where they want to be taken care of, which is in their homes and not in hospitals or extended stay facilities.

Home health care and hospice frequently work with people in some of the most difficult times in their lives, when they are facing those difficult, often final, illnesses and they want to do it at home. They don't want to be in the hospital. They want to be at home with family and friends around comfortable surroundings. In this underlying base bill, home health care is cut $42 billion from the people who need it the most and from agencies that need it the most and are in dire straits.

I have a chart up here which shows the impact on my State, particularly on home health care agencies. Roughly $240 million in cuts to home health care agencies in the State of Kansas will take place under this base bill. In this base bill, 64 percent of the home health agencies in Kansas will go broke by 2016, 64 percent by 2016. So just at the point in time where you have a lot of uptake and need for home health care for some people who are aging at that point in time, you are going to cut and you are going to cut this much, $240 million in my State, 64 percent of them go broke, and for what?

Supposedly, it is to save a bunch of money, right? Well, on top of this, the CMS Office of the Actuary recently pointed out that the drastic cut to home health care will not produce savings to the Medicare Program. According to OACT, the savings from permanent annual productivity adjustments are unrealistic.

Again, that just stands to reason; if you are going to force people out of their homes into a hospital for extended care because you are cutting home health care, you are not going to save money in that system. You are going to spend more money in that system. This is not going to work. It is going to hurt people overall, and it is going to be at a point in their lives when they would rather be at home than in the hospital.

I think these are cruel cuts. I think it is at a terrible time. That is just for home health care, that alone, and then with the hospice. I have a letter from the Kansas Home Care Association that I wish to ask unanimous consent of the Presiding Officer to have printed in the Record at the end of my statement.

They say in this sentence, among other things:

This will cause an increase in patients seeking care in

more expensive institutions which will only cause more of a

drain on State and Federal budgets.

It is projected that over 58 percent of Kansas home health

agencies will operate at a negative margin in 2010. . . .

I noted to you the number that is going to go broke by 2016. This isn't a far-off prospect. This is even next year, under the current setting. Then they are going to cut another $240 million from the Kansas ones that will cause even more of them to have great difficulty and financial trouble at this point in time.

I ask my colleagues to revisit this issue. Vote for the Johanns motion that supports home health care agencies. The Johanns motion is simple. It says: Look, restore this piece. Don't take these moneys from home health care agencies. For a number of us who represent a number of rural States, home health care is key. It can be expensive in a rural setting. They need the resources to be able to meet the needs of the seniors we have.

On top of that, in the overall cuts that are taking place are key and major cuts to Medicare Advantage programs. Referring to the chart, there will be a 63.7-percent cut to Medicare Advantage benefits that will affect more than 1 in 10 Kansas Medicare beneficiaries. A $1.5 billion cut to Kansas hospitals is taking place and an 11.8-percent cut in hospice payments. Home health care agencies often do hospice care as well. So this is a double cut for them.

Again, this is at a point in time in life where it is the most difficult. There is $124 million in cuts of skilled nursing facilities as well. This will force more people into that setting.

Exhibit 1

Kansas Home Care Association,

Topeka, KS, December 4, 2009.

Hon. Pat Roberts,

Senator from Kansas.

Dear Senator Roberts: On behalf of the Home Health Care and

Hospice agencies of Kansas, we would like to support the

Republican Senators motions to commit back to the Senate

Finance Committee the HCR bill with changes that do not

include cuts in payments to both home health and hospice

agencies.

This bill includes cuts to home health agencies that total

$42.1 billion and cuts to hospice agencies of $7.7 billion.

In Kansas a number of our member agencies service both home

care patients and hospice patients, so they would be hit

twice with monstrous cuts.

It is projected that over 58 percent of Kansas home health

agencies will operate at a negative margin in 2010 and that

number increases significantly in years to follow. Hospice

agencies have already sustained cuts that have limited access

to the Hospice benefit, particularly in rural areas, which of

course is much of Kansas.

Last week Governor Mark Parkinson announced a 10 percent

cut to Medicaid providers in order to balance the state

budget. Agencies that provide services to Medicaid clients

cannot sustain such drastic cuts and access will be severely

limited. This will cause an increase in patients seeking care

in more expensive institutions which will only cause more of

a drain on state and federal budgets.

On behalf of the Kansas Home Care Association members, we

applaud your efforts to block cuts to home health care and

hospice benefits that the citizens of Kansas and the United

States need and deserve.

Sincerely yours,

Jane Kelly,

Executive Director.

Madam President, I rise in support of the amendment of the Senator from Alaska, and I have talked with my good friend, the Senator from Maryland, Ms. Mikulski, about a side issue in this overall debate about what is included in the definition of preventive care. The Senator from Maryland stated in a colloquy that ``there are no abortion services included in the Mikulski amendment.'' She has stated that in colloquy.

I have trouble, however, because I believe a future bureaucracy could interpret it differently. So I asked my friend from Maryland if she would include clear legislative language in this saying simply:

Nothing in this Act shall be construed to authorize the

Secretary, or any other governmental or quasi-governmental

entity, to define or classify abortion or abortion services

as ``preventive care'' or as a ``preventive service.''

I think that clarifies the issue, and it would be my hope that my colleague from Maryland would include that in her language. It is not in there, even though there have been statements on the floor. But, as we all know as legislators, it is one thing to say something on the Senate floor, and it is one thing to have a colloquy, but it is far different to have it written in the base law. This is not in the base law.

So I would urge my colleague, the Senator from Maryland, to include this language. Absent that, I think there is too much room for a broader definition of what preventive care means; that it could include abortion services as well, and I would urge my colleagues to vote against the Mikulski amendment if that is the case.

On that ground, I think there are other issues involved, and that is why I think the approach of the Senator from

Alaska is superior, while maintaining the doctor-patient privilege. I think this is a good debate for us to have, given these recent discussions. But absent this change, I think there is another issue that is involved that I would urge my colleagues to consider.

Madam President, I want to yield back to maintain some time for the Senator from Wyoming to be able to speak, so I yield the floor.

Mr. President, I rise to speak in favor of the McCain motion, and I do it from the perspective of a representative of the State of Kansas.

We have a number of senior citizens and hospitals that are Medicare- dependent. We have a number of providers for whom a majority of their practice is Medicare reimbursement. They are scared to death of these cuts, and the cuts are well documented--$500 billion in Medicare cuts, and for the 43 million senior citizens on a program that is already projected to go insolvent by 2017, specific cuts of $135 billion from hospitals, $120 billion from 11 million seniors in Medicare Advantage, nearly $15 billion from nursing homes, nearly $40 billion from home health agencies, and then--a cruel gesture, it seems to me--nearly $8 billion from hospice, where people are getting their final care for cancer and diseases that are killing them--$8 billion cut from hospice.

What that does in a State such as mine and in many rural hospitals, it cuts the legs out from under them. They are not going to have the money they need to operate. They are going to do everything they can to continue to operate--and they will, probably. What they will try to do is tax their local citizenry, raise property taxes, in all probability, to make up for the Medicare cuts because they are going to have a hospital there and they are going to do everything they can to keep a hospital there.

But what a terrible gesture on our part here, to take money that has been going into Medicare--and people have been paying into Medicare-- and then steal it for a new program that is not going to get everybody covered on top of that and from a program that is already set to go insolvent by 2017. It is like writing a big fat check on an overdrawn bank account to start something new, to buy a new motorcycle. That doesn't make sense to people. Then it seems cruel and unusual to the senior citizens that you are taking $500 billion and really gutting a lot of their care programs on a program that doesn't work.

I met earlier, within the last several days, with the Kansas Association of

Anesthesiologists. They are looking at these things and saying: This is really going to hurt us and our ability to provide services and care. I talked with other individuals who look at this, and they say: Wait a minute, you are going to change everything to try to get a few more people covered and you are going to gut a Medicare program that is not paying the bills now, that a number of private insurance plans are helping to subsidize Medicare and Medicaid, and you are going to cut the reimbursements that are not making things work yet? It makes no sense to individuals that this would take place.

I get called by a number of individuals across the State of Kansas saying they are very scared of this bill and what it is going to do to their health care. I do telephone townhall meetings, as a number of individuals across this body do, and the individuals there whom you get on a random phone calling basis are scared and mad about this bill and the prospects of what it does to their health care. I get it from individuals. I get it from mail.

I was in a meeting in Kansas the week of Thanksgiving, and I polled the audience--it was an audience that was mostly over the age of 65-- how many were in favor of the overall bill? There were about 200-some people there, and 10 were in favor. How many opposed? Everybody else, with a few saying they don't have an opinion. But it was 90 percent, 95 percent opposed to this bill, and it is because they look at it and they see what it is going to do to them, and they don't see it providing the care that is being promised--and adding, on top of that, to the deficit.

One of two things is going to happen on these Medicare cuts, because we have seen, in the past, efforts to control the spending in Medicare passed by this body and then each year those cuts to try to restrain the spending on Medicare being restored.

One of two things is going to happen. Either these cuts in Medicare are going to take place, and it is going to cripple the program and particularly hurt it in a number of rural areas across the country and in my State, or these cuts will never take place in Medicare and it is going to add to a ballooning deficit and debt that is taking place right now. Either choice is an irresponsible choice for this body to do. It is irresponsible for us to do for this country. Most people look at it and say: I want to get more people covered, and I want to bend down the cost curve. But let's do that on an incremental basis.

Senator Kyl spoke about incremental changes that can take place, whether it is tort reform, allowing bigger pooling on health insurance, whether it is starting more community-based clinics, one that I look at as something that has worked in my State to get more people covered at an earlier phase in their health care needs. All of those are incremental, low cost, and, in some cases, ones that actually do bend down the cost curve and that can help, not a gargantuan $2.5 trillion program that takes $500 billion out of Medicare that is already headed toward insolvency in less than a decade. The bill doesn't make sense to individuals.

Then to do it on top of a time period when the President, 10 days ago, comes back from China, meeting with our bankers, as most people look at it, and the bankers lecturing us on why are we spending more money which we don't have, going further and further into debt, which we should not do at this point in time, being lectured by the Chinese when we ought to be talking to them about what they are doing about human rights and currency. We are being lectured about fiscal irresponsibility, and it is because of bills such as this. If we just stop and slow down and listen to seniors and others across this country, there is a commonsense middle ground that we can go to, that doesn't cost anything along the nature of this, doesn't change health care for most people but addresses the narrow problem of getting the cost curve down, of getting more people covered. This bill with these cuts in Medicare cripples many of my providers in the State of Kansas and will make them raise property taxes to keep the hospitals open, to try to provide doctors in the community--a lot of the hospitals are going to close and a lot of providers will stop providing Medicare--or, in all probability, these cuts will never happen, and it will be added to the debt and deficit, completely irresponsible toward our kids.

I urge my colleagues to vote for the McCain motion that makes sense, that is what the citizenry wants to do: send these cuts in Medicare back to communities and pull out of this bill.

I yield the floor.

Madam President, I, first, thank my colleague for offering these amendments in committee.

In both the HELP and Finance Committees, you said: Let's put in the Hyde language, and both times the amendments were defeated in committee. I appreciate my colleague raising it. Proponents of the Reid bill will tell us the abortion funding language is essentially the Hyde language included in the annual Labor-HHS appropriations bill. That is plain wrong. The Hyde amendment specifically removes abortion from government programs. The Reid bill specifically allows abortion to be offered in two huge new government programs. The Reid bill tries to explain this contradiction by calling for segregation of Federal dollars when Federal subsidies are used to purchase health plans. This segregation of funds, though, actually violates the Hyde amendment, which prevents funding of abortion not only by Federal funds but also by State matching funds within the same plan. Simply put, today Federal and State Medicaid dollars are not segregated, and the Reid bill specifically authorizes something the Hyde amendment specifically rejects.

Well, if I could follow up quickly on the last point, I think it is clear that if we are not going to put this in the Federal employees benefit insurance system, then we should not put it in this system. Yet this is a billing expansion that is taking place. The Democratic health bill would explicitly authorize abortion to be covered in the government option. It also mandates that there must be abortion coverage in every insurance market in the country. This is an enormous expansion, a radical departure from the 30-year policy that represents the Hyde amendment. The abortion language that was included in the bill is a huge departure from 30 years of bipartisan Federal policy prohibiting Federal tax dollars paying for elective abortions. The language in the Senate bill explicitly authorizes the Secretary of Health and Human Services to include abortion in the public option and permits government subsidies for plans that pay for abortion.

The Capps language, commonly referred to in the Senate bill, contains a clever accounting gimmick that proponents say separates private and public funds for abortion coverage. However, it has been proven over and over by outside reviewers that the Capps measure would include both abortion coverage and funding in the government-run public option as well as for those plans in the insurance exchange. Representative Bart Stupak, a Democrat from Michigan, explained the issue very clearly in an op-ed he wrote yesterday. He wrote:

The Capps amendment, which is the basis of the Senate

language, departed from Hyde in several important and

troubling ways: By mandating that at least one plan in the

health insurance exchange provide abortion coverage; by

requiring a minimum $1 monthly charge for all covered

individuals that would go towards paying for abortions; and

by allowing individuals receiving Federal affordability

credits to purchase health insurance plans that cover

abortion. Hyde currently prohibits direct Federal funding of

abortion. The Stupak amendment is a continuation of that

policy--nothing more, nothing less.

I would like to ask Senator Hatch about this provision, about what we need to talk about on the exchanges and the types of plans that will be included in the exchanges and about how this is an expansion of the abortion language.

The Reid health care reform bill would require at least one health care plan to offer elective abortions in each State health insurance exchange. However, nothing in the Reid bill ensures that the one plan that must cover elective abortions be the plan that is most affordable or least affordable. In other words, if I do not wish to have a plan that covers elective abortions but all I can afford is that plan, where does that leave me? Should my constituents have to compromise their own moral code in order to receive health care; in other words, that they would have to buy a plan that covers abortion?

Today, no Federal health program requires the coverage of elective abortions. This is a clear departure from current law, and I cannot imagine us forcing people to pay for insurance that covers abortions when it is so unconscionable to so many of the American people.

I also would like to make one other point perfectly clear. The Stupak-Pitts compromise amendment would not prohibit the ability of women to obtain elective abortions as long as they use their own money to purchase these policies. I think it is important we get that piece of it clear as well.

Well, I think this is a key thing for us to keep in mind, that it is true that women can purchase separately, with their own money, use their own funds to be able to provide for their own abortion coverage. But what we are saying here today is that we should not have this as part of the Federal Government. We should not have it as part of the Federal funding program. We should not be using taxpayer dollars to fund abortions, as we have not done for 30 years. That has been the longstanding bipartisan program. But it is not prohibited that an individual could go ahead and buy this service on their own.

I say to Senator Hatch, as someone who has been in this body for some years and as someone who has followed this issue courageously for many years, what we are asking for, again, is just what has been established since 1977 in this body and in the House.

I was there that evening, along with the Senator and Senator Hatch and almost all of the Senators, when the President was addressing us on health care. I remember vividly sitting there and listening to these words, the ones you just mentioned. He was very clear, very concise; there was no fudging around on it:

And one more misunderstanding I want to clear up--under our

plan, no federal dollars will be used to fund abortions, and

federal conscience laws will remain in place.

Yes, that is specifically violated in the bill, and they had a very simple route to change it. They could have just put the Stupak language in that has already passed the House. That is the Hyde language that has been agreed to by this body and others for 30 years here. Instead, they put in this abortion-expansion language.

I will show another chart here a little bit later on. The last time we funded abortions here was between 1974 and 1977, right after Roe v. Wade and before the Hyde language in 1977. Do you know how many abortions were funded annually by the Federal Government at that period of time? If we are going back to that policy, if we are looking to go back to that era where the Federal Government was funding it, Medicaid funded as many as 300,000--300,000 annually. Now, I would ask everybody, pro-choice or pro-life, do you want your taxpayer dollars to pay for 300,000 abortions a year? I do not think anybody wants to see us do that.

President Clinton we all remember very clearly saying often that he wanted to make abortion safe, legal, and rare. Adding 300,000 does not do that.

So the President took the time, in a carefully tailored and vetted speech that all of us were there to hear--the Presiding Officer, as well; it was nationally televised in prime time--to tell Congress the words we have quoted here today and to make that specific promise. And that promise is broken in the Reid legislation before us today. We sat there in the House Chamber and heard him say those words. Our constituents watching the speech at home heard those words. I have to believe these are the kinds of broken promises that are making our constituents lose their trust in government.

But the fact is, as so many people have pointed out, abortion is very much in this health care bill. Many Democrats and Republicans acknowledge this. Mr. Stupak, whom I have quoted several times, is just one of them.

If we want to do more than just pay lipservice to lowering the incidence of abortion, we need to oppose the motion to proceed, and we should have had the Stupak compromise language included in the bill in the first place since the President clearly stated he did not want Federal dollars to be used for the funding of abortion.

Consider the fact that when Federal funding is not available for abortion, fewer abortions occur. When Federal funding is available, as we have seen in the past, thousands more will occur.

As shown on this chart, here is why the Hyde amendment is so important. The administrators running the Medicaid Program funded, as I noted, over 300,000 per year. That is almost 1 million abortions paid for by the country's taxpayers out of their pockets when the Hyde language was not the law of the land. That was until the Hyde amendment was enacted in 1976 because the American people disagreed with being forced to pay for abortions. Whether they are pro-choice or pro-life, they did not want taxpayer dollars to go for this.

One other example of government ushering abortion policy through health care legislation is when the Commonwealth of Massachusetts recently passed its State-mandated insurance, Commonwealth Care. They failed to include an explicit exclusion of abortion, like Senator Hatch tried to get in committee or like they had in the House language, the Stupak language, so abortions there were funded immediately in Massachusetts. In fact, according to the Commonwealth Care Web site, abortion is considered covered under ``outpatient medical care.''

The Federal Government should not go down this road. The President made a commitment to the American people, and the Democrat-led Senate has failed to include that commitment in this bill. They included radical language that will increase the incidence of abortion.

I say to Senator Johanns, don't you think it makes sense to protect health care providers, when we look at that issue here, who have objections of conscience to abortions so they are not forced to provide abortions?

Please do.

I was recently at a Veterans Day parade in Leavenworth, KS, and I had a number of people coming up to me opposed to the health care bill. I had one come up to me and say they were in favor of it and all the rest were opposed. It starts on the basis that it is fiscally insane what we are considering doing with $12 billion in debt, and then we are going to add a multitrillion-dollar entitlement program on top of this. The Federal Government is hemorrhaging money. Why on Earth would we do that? Then they are scared about what else is in the bill, and then this feature comes up as well.

Finally, Senator Johanns was putting in statements from various groups, and I ask unanimous consent that this statement from the United States Conference of Catholic Bishops be included at the end of our colloquy.

The Catholic Bishops issued this yesterday and said this:

The legislative proposal recently unveiled in the Senate

does not meet these moral criteria. Specifically, it violates

the longstanding Federal policy against the use of Federal

funds for elective abortions and health plans that include

such abortions--a policy upheld in all health programs

covered by the Hyde Amendment, the Children's Health

Insurance Program--

SCHIP, which Senator Hatch helped to get started--

the Federal Employees Health Benefits Program--

that Senator Johanns spoke about--

and now in the House-passed ``Affordable Health Care for

America Act.'' We believe legislation that violates this

moral principle is not true health care reform and must be

amended to reflect it. If that fails, the current legislation

should be opposed.

This is the Catholic Bishops, generally in favor of health care reform, and they are saying this fails on this account and must not be in this legislation and can't be considered as part of health care reform.

It has been my pleasure to join Senators Hatch and Johanns on this effort. I have worked with both of them in many different capacities and jobs.

This is as serious a pro-life vote as I have seen. If this gets passed, the Federal Government will be funding somewhere north of 300,000 abortions a year. If it was 300,000 back in the 1974-to-1976 timeframe, with the growth in U.S. population, you are probably looking at north of that number of Federal taxpayer dollars funding abortions. I cannot imagine many people in this country being satisfied about that kind of number taking place. I can't imagine that. But that is our past experience when the government funds abortion.

Those are the numbers we are talking about. I note, too, the country has a longstanding ethic and moral code. We are a moral people, and we have been from the outset. Some people say this or that, but a big part of that has been that basic moral code, that basic thought within the Judeo-Christian ethic that we respect life. This goes back to when Moses talks to the people about going into the Promised Land. He is giving his last lecture to the Jewish people before going into the Promised Land. In that last lecture--Moses doesn't get to go in himself, but he gets the people together. They march for 40 years in the wilderness. He knows he is not going in, but they are, and he gives a lecture.

Deuteronomy 30:19 says something that is applicable here:

This day I call heaven and earth as witnesses against you

that I have set before you life and death, blessings and

curses. Now choose life, so that you and your children may

live.

This is in the fundamental ethic and background of our country. That is what we have to choose today. Do we choose life or death? Choose life, so that you and your children might live.

As Senator Johanns notes, we just need one vote on the other side to change this, and this language gets pulled out and Stupak gets put in. Just one vote. If we cannot get to 60--and you have to get there--and that one person says: I am not going to do it, unless you put Stupak in this, it changes. We need just one to choose life, and it will change. It has been a pleasure to join with both Senators today.

Exhibit 1

United States Conference

of Catholic Bishops,

Washington, DC, November 20, 2009.

U.S. Senate,

Washington, DC.

Dear Senator: On behalf of the United States Conference of

Catholic Bishops (USCCB), we strongly urge the Senate to

incorporate essential changes to the Senate's health care

reform bill to ensure that needed health care reform

legislation truly protects the life, dignity, consciences and

health of all. We especially urge the Senate to act as the

House has in the following respects:

Keep in place current federal law on abortion funding and

conscience protections on abortion;

Protect the access to health care that immigrants currently

have and remove current barriers to access; and

Include strong provisions for adequate affordability and

coverage standards.

The Catholic Bishops of the United States have long

supported adequate and affordable health care for all. As

pastors and teachers, we believe genuine health care reform

must protect human life and dignity, not threaten them,

especially for the most voiceless and vulnerable. We believe

health care legislation must respect the consciences of

providers, taxpayers, and others, not violate them. We

believe universal coverage should be truly universal, not

deny health care to those in need because of their condition,

age, where they come from or when they arrive here. Providing

affordable and accessible health care that clearly reflects

these fundamental principles is a public good, moral

imperative and urgent national priority.

Sadly, the legislative proposal recently unveiled in the

Senate does not meet these moral criteria. Specifically, it

violates the longstanding federal policy against the use of

federal funds for elective abortions and health plans that

include such abortions--a policy upheld in all health

programs covered by the Hyde Amendment, the Children's Health

Insurance Program, the Federal Employee Health Benefits

Program--and now in the House-passed ``Affordable Health Care

for America Act.'' We believe legislation that violates this

moral principle is not true health care reform and must be

amended to reflect it. If that fails, the current legislation

should be opposed.

Protecting Human Life and Conscience

Specifically, we urge you to include the House-passed

provision that keeps in place the longstanding and widely

supported federal policy against government funding of

elective abortions or plans that include elective abortions.

In the aftermath of the overwhelming and bipartisan House

vote for the Stupak-Smith-Ellsworth-Kaptur-Dahlkemper-Pitts

Amendment, there has been much misunderstanding of what it

does and does not do. This amendment does not change the

current situation in our country: Abortion is legal and

available, but no federal dollars can be used to pay for

elective abortions or plans that include elective abortions.

This provision simply keeps in place existing policy and

allows Congress to honor the President's commitment that ``no

federal dollars will be used to fund abortions.'' The

amendment does not restrict abortion, or prevent people from

buying insurance covering abortion with their own funds. It

simply ensures that where federal funds are involved, people

are not required to pay for other people's abortions.

Thus far, the pending Senate bill does not live up to

President Obama's commitment of barring the use of federal

dollars for abortion and maintaining current conscience laws.

The bill provides federal funding for plans that cover

abortion, and creates an unprecedented mandatory ``abortion

surcharge'' in such plans that will require pro-life

purchasers to pay directly and explicitly for other people's

abortions. Its version of a public health plan (the

``community health insurance plan'') allows the Secretary of

HHS to mandate coverage of unlimited abortions nationwide,

and also allows each state to mandate such abortion coverage

for all state residents taking part in this federal program

even if the Secretary does not do so. The bill seriously

weakens the current nondiscrimination policy protecting

providers who decline involvement in abortion, providing

stronger protection for facilities that perform and promote

abortion than for those which do not. The legislation

requires each region of the insurance exchange to include at

least one health plan with unlimited abortion, contrary to

the policy of all other federal health programs. Finally,

critically important conscience protections on issues beyond

abortion have yet to be included in the bill. To take just

one example, the bill fails to ensure that even religious

institutions would retain the freedom to offer their own

employees health insurance coverage that conforms to the

institution's teaching. On these various issues the new

Senate bill is an enormous disappointment, creating new and

completely unacceptable federal policy that endangers human

life and rights of conscience.

Immigrants and Health Care Coverage

We support the inclusion of all immigrants, regardless of

status, in the insurance exchange. The Senate legislation

forbids undocumented immigrants from purchasing health-care

coverage in the exchange. Undocumented immigrants should not

be

barred from purchasing a health insurance plan with their own

money. Without such access, many immigrant families would be

unable to receive primary care and be compelled to rely on

emergency room care. This would harm not only immigrants and

their families, but also the general public health. Moreover,

the financial burden on the American public would be higher,

as Americans would pay for uncompensated medical care through

the federal budget or higher insurance rates.

We also support the removal of the five-year ban on legal

immigrants accessing federal health benefit programs, such as

Medicaid, the Children's Health Insurance Program, and

Medicare. Legal immigrants, who work and pay taxes, should

have access to such programs if needed. Removing the ban

would help ensure that legal immigrants, who were widely

praised in past immigration debates for their many

contributions and for playing by the rules, will still have

access to health care.

Accessible and Affordable Health Care

The Catholic bishops have advocated for decades for

affordable and accessible health care for all, especially the

poor and marginalized. The Senate bill makes great progress

in covering people in our nation. However, the Senate bill

would still leave over 24 million people in our nation

without health insurance. This is not acceptable.

The bishops support the expansion of Medicaid eligibility

for people living at 133 percent or lower of the federal

poverty level. The bill does not burden states with excessive

Medicaid matching rates. The affordability credits will help

lower-income families purchase insurance coverage through the

Health Insurance Exchange. However, the Senate bill would

still leave low-income families earning between 133 and 250

percent of the federal poverty level financially vulnerable

to health care costs. Overall, the average subsidy provided

for in the Senate bill is $1,300 less than the average

subsidy in the House bill. Improvements to the bill should be

made so that low-income families have reasonable out of

pocket expense for health care.

Immediate reforms are included in the bill that should be

helpful in providing relief to the uninsured and

underinsured. Additionally, reforms that will strengthen

families and protect low-income and vulnerable people such as

eliminating denial of coverage based on pre-existing

conditions including pregnancy; eliminating life time caps;

offering long-term disability services; and extending

dependent coverage to uninsured young adults--are significant

steps toward genuine health care reform. We urge the Senate

to maintain these provisions.

These moral criteria and policy objectives are not marginal

issues or special interest concerns. They are the questions

at the heart of the health care debate: Whose lives and

health are to be protected and whose are not? Will the

federal government, for the first time in decades, require

people to pay for other peoples' abortions? Will immigrants

be worse off as a result of health care reform? At their

core, these health care choices are not just political,

technical, or economic, but also moral decisions. This

legislation is about life and death, who can take their

children to the doctor and who cannot, who can afford decent

health care coverage and who are left to fend for themselves.

Our appeal for health care legislation that truly protects

the life, dignity, health and consciences of all reflects the

unique perspectives and experience of the Catholic community.

Our hospitals, clinics, and long-term care facilities provide

quality health care to millions. Our dioceses, institutions,

and ministries purchase health care for many thousands of

employees and their families. Our emergency rooms, shelters,

clinics, and charities pick up the pieces of a failing health

care system. Our Catholic moral tradition teaches that health

care is a basic human right, essential to protecting human

life and dignity.

For many months, our Bishops' conference has been working

with members of Congress, the Administration and others to

fashion health care reform legislation that truly protects

the life, dignity, health and consciences of all. Our message

has been clear and consistent throughout. We hope and pray

that the Congress and the country will come together around

genuine reform.

Sincerely,

Bishop William F. Murphy,

Diocese of Rockville Centre, Chairman, Committee on

Domestic Justice and Human Development.

Cardinal Daniel DiNardo,

Archdiocese of Galveston-Houston Chairman, Committee on

Pro-life Activities.

Bishop John Wester,

Diocese of Salt Lake City, Chairman, Committee on

Migration.

I don't think they are particularly confused. I think they smell a rat in this and they know if you are going to add this big of a program, somebody is going to tax me somewhere here.

The interesting way this is actually scored in the bill is the government uses the old heavy hand of inflation. As

we have heard, many economists have spoken in the past about how inflation is the most cruel tax of all, particularly for the people on a fixed income, because then the base dollars they have do not go as far as they used to. What is scored in this bill--and we have seen this time and time again--is what you have as an inflation factor that is not indexed. It is not indexed.

I wish to show these charts here to prove it. At the end of how this is scored, we will end up having people who have subsidized insurance when they start out, but that in the outyears in the scoring will be taxed for having subsidized insurance. So we will be both taxing them at the same time as we are subsidizing their insurance. And we are also--and I will show a chart here in a minute--taxing their insurance plan that we are subsidizing at the same time, and that is built into the base score. So then that is how you get to a CBO score that, presto chango, the budget is balanced; we are even producing a surplus. It is this cruelty of inflation.

People can remember back to the Jimmy Carter days with 10 percent inflation. They know what that did to them. Look at this. This is all in the CBO scoring. This is from the Joint Economic Committee staff who have been working through these calculations to see, How do you come up with adding a multitrillion-dollar entitlement program and come to a budget deficit-neutral facet to it? What we see here is surtax levels-- and this is kind of a busy chart--but this red line is 100 percent of poverty in 2009 and 100 percent of poverty built out over 100 years, which is also part of the scoring system, and then the median income of married households. What you see is families receiving subsidies beginning to pay the surtax in the scoring of this. That is all due to the cruelty of inflation.

That is absolutely correct, and it is the same technique. This is the alternative minimum tax on steroids in the insurance industry and in the insurance field. It is the same thing. We fix it every year. That is why this is such a fraud. Do you really think we are going to tax people for their health insurance at the same time we are subsidizing their purchase of health insurance? That isn't going to happen, so those dollars aren't going to arrive. So where are those dollars going to come from? It will be from deficit and debt, or you are going to have this cruelty of inflation taking place.

The bill funds health care reform with increased Medicare taxes. We are going to see that taking place in this as well.

Here is the chart I like that I will show. It demonstrates how we are going to have these Chevrolet plans--you have heard of these health insurance plans. Let me put this chart up. We are going to tax the Cadillac plans, all right? Well, it turns out under this bill, the Chevy becomes a Cadillac. So you are going to tax the Cadillac when it is still a Chevy. That is because of inflation.

Most people know their health insurance premiums have been going up pretty consistently over time. Well, it turns out that the Chevy will metamorphose into a Cadillac and it gets taxed and that is in the CBO scoring of this bill, and that is how you come out with balancing the cost of the bill.

None of this is going to happen. You will have some sort of AMT-type fix that will take place on an annual basis, and at the end of the day you get a big debt and deficit you are going to have with it or horribly cruel high levels of inflation or maybe both.

No, I haven't seen that take place.

No, and I don't know that there would be 5 percent of the public in my State who would believe that, because their experience tells them differently. Their experience tells them: Look, I know you guys make these great promises and everything, but I also know the further out you make this promise, the less reliable your data, and I have seen that whenever the government gets into things, it always costs a lot more and it seems as though our debt and deficit always keeps growing and it is way too big.

What is troubling is that this is built into the base of how we get to the numbers of getting this as a budget-neutral matter. This isn't going to happen. On top of all of that, you say we are going to save $400 billion in Medicare. We have now voted four times for the so- called doctor fix, which was a slight reduction in Medicare spending for providers, and I voted for it three times, to fix it, on an annual basis. Do you possibly think--possibly think--that the Congress is going to cut Medicare $400 billion, that people are going to come back here and say, You can't do that, you are going to be ruining Medicare and that Congress will fix it? I said this to Treasury Secretary Geithner yesterday: Our experience has never been to do something like that. So where does the money go? It goes right on the deficit and the debt and you are going to add to that $12 trillion estimate. We are hemorrhaging Federal money and, at the same time, the global community is saying, you have to get your fiscal house in order.

We just had our President over in China, hat in hand, with our bankers saying, OK, we think human rights is pretty important, but we need that loan. What we are going to see take place, because this is a fiscally irresponsible package, I think we are going to see the international community saying words are one thing but action is what talks, and we are going to start pulling capital out of the U.S. marketplace. It is going to drive up interest rates, it is going to drive up inflation.

So maybe this scenario happens, but it is cruelly done through inflation, and it is not fair to the American public.

In my State of Kansas, a huge budget debate is going on about where we are going to come up with the shortfall this year in the State budget. People can save in some places, but you have to do this on Medicaid. It ends up, in all probability, that a disproportionate share will come out of the schools for the schoolchildren. Is that what we at the Federal level want to see take place? No. That is one of the reasons I am voting against this bill. You are dictating a State budget. Initially the Feds are putting in the full amount, but I have seen this before too. You start with the Federal Government wiggling the carrot, saying: Take a bite. You can do it. Then once you get hooked, you say: OK, we are going to reel it in now, and you will pay more of it. It will be the Federal Government dictating the State budget, putting it into Medicaid and taking it away from schools. That is what will take place. That is what is happening in my State now.

It is not fair to do that. It is not right for us to do that. Most of the people across Kansas think this whole issue is fiscal insanity-- literally fiscal insanity--what we are looking at doing with that level of debt, $12 trillion a year. With my State having the level of debt it has, making this requirement--a multi-trillion-dollar entitlement expansion when the Federal Government is hemorrhaging money, as well as State governments--is fiscal insanity. The world community is saying: Get your fiscal house in order. This makes no sense.

I certainly think it is. What I observe, too, is people coming up to me in large numbers and very passionately saying they are both mad and scared. They are mad about this taking place, and they are scared it is going to actually happen to them. They feel like, how can this happen to them in this country? They look at that huge debt and at our President over in China talking as if he is going to see the banker, and they don't like it. This isn't their country the way they want it to be. They want our country to be fiscally sound instead of going to beg hat-in-hand to the ``banker'' in a foreign country. Then you are going to add another big entitlement on top of that? They are saying: Don't ask me, the taxpayer, for more money because I don't have it. They are mad and scared about this. It is very disconcerting for people in the country.

Yes, our President got lectured by the Chinese regulator about our financial system. This is unbelievable. This exacerbates it, if we pass this bill.

Mr. President, I suggest the absence of a quorum.

Mr. President, I am glad to follow my colleague from Utah. I have great admiration and affection for him. He has done a lot of good, bipartisan legislation. I hope my colleagues will heed his word. He is good to his word, and he would be willing to do a bipartisan bill.

On top of that, if the Democratic leadership would back up and do a bipartisan bill, the American people would cheer. They would think this was extraordinary, and we could get something substantive done and not this monster.

I am ranking member of the Joint Economic Committee, and we had Secretary Geithner in to testify today. I disagree with a number of things he has done. He is a bright and energetic man with a lot of experience. I noted to him--and he knows this is the case--that we are $12 trillion in the hole. We are hemorrhaging money at the Federal level. Why on Earth we would do the fiscally insane thing of adding a multitrillion dollar entitlement program, when we are $12 trillion in the hole and hemorrhaging Federal money, and you have the President just back from seeing the bankers in China, who have nearly a trillion dollars of our debt? As a Senator and as an American, I don't like that we are dependent upon the Chinese for that much money. I don't think the American people like that. Why on Earth would we do this? He said that people are mad out there. We talked ahead of time, and he said that people are upset across the country. I said, yes, they are, and it is because of this. They are mad and they are scared. Neither of those is a situation where you ought to try to force something through on people who are mad and scared about it. They are mad about things being rammed through, and they are scared about the level of debt and deficit, and they are adding this scale of entitlement on top of an already broken fiscal situation.

The rest of the world is yelling at the United States to get your fiscal house in order, and we are going to add a multitrillion dollar entitlement program, when we all know we ought to get our fiscal house in order. Then the way it is paid for is to raise taxes $\1/2\ trillion in a weak economy. That is going to hurt the economic expansion and job creation we need. Then you are supposedly going to save $400 billion out of Medicare, which I noted to him. That song has been tried in the past. We had these fixes that we were going to reduce payments to providers, to the physician community. For 4 years now in a row we have changed and said we were going to do this provider cut--a minor provider cut--and then Congress said that is too much, we are not going to do that. We will fill that back up. For three or four of those, I have voted for that.

Then there is the idea that we are going to cut $400 billion out of Medicare, which is already on a fiscally irresponsible track and going broke. We are going to take $400 billion out of that. That is not going to happen. If it did happen, it would wreck Medicare. This is a bad idea at a bad time. We should not do this. We should not do it this way.

I want to focus more of my comments on a narrower piece of this, which has gotten a lot of focus in the House and should get focus in the Senate. It is the radical expansion of Federal funding of abortions that is in this bill. Let's put it on its bottom line. They should put the Stupak language in the Senate bill, and instead the Capps language is in the bill. The Capps language will expand Federal financing of abortion--Federal taxpayer funding of abortion. The Stupak language is something we have supported here for 30 years. It is the Hyde language--the language that 64 Democrats voted for in the House. Instead, in this bill you have Federal taxpayer funding of abortions, something we have not done for 30 years. They are going to build it into this bill. The President has said that he wants--he has said multiple times it is one of his goals to lower the incidence of abortion. This bill, if we pass it, will provide, for the first time in 30 years, taxpayer funding of abortion and will expand abortions-- counter to what the President has said multiple times.

Nobody who is pro-life should vote for this bill. This is a radical expansion of abortion funding. It is a radical expansion of abortion. I was and remain very disappointed that the Senate leadership and my Democratic colleagues have attempted to insert radical abortion policy through the Democratic health care bill. Abortion is not health care. Any Senator who votes on the motion to proceed to this health care bill is voting in favor of abortion and the expansion of abortion and against life.

This is the biggest pro-life vote in the Senate in years. This will have more impact on abortions in the United States--an expansion of it--than anything we have seen in years. We have been on a downward trajectory on abortion because both sides have agreed; Democrats have said abortions should be safe, legal, and rare. Former President Clinton and others have said this will make taxpayer funding of abortion--this will expand it. And there is nothing rare about it.

Relevant abortion language in the health care bill to which I am referring could be found on pages 116 to 124. The National Right to Life Committee described the language and said it is completely unacceptable. The Democratic health care bill would explicitly authorize abortion to be covered under the government option, and there must be abortion coverage in every insurance market in the country. The abortion language included in the bill is a radical departure from over 30 years of bipartisan Federal policy prohibiting Federal taxpayer dollars from paying for elective abortions. The language in the bill explicitly authorizes the Secretary of Health and Human Services to include abortion in the public option and permits government subsidies in plans that pay for abortion. We have had a long dispute in Congress and in this body about abortion. We have not had a dispute to near that degree--some, but not near the level of dispute on the taxpayer funding of abortion, because most people are opposed to that--most people in America. They may say, OK, I am all right with abortion, but I don't support Federal taxpayer funding of it. That has been a broad, bipartisan support here for some time. It is explicitly in this bill. It is the Capps language. It is commonly referred to as that. It is in the Senate bill and contains a clever accounting gimmick that proponents say separates private and public funds for abortion coverage.

However, it has been proven that the Capps measure would include both abortion coverage and funding in the government-run public option, as well as for those plans in the insurance exchange.

The only acceptable abortion language is the Stupak-Pitts amendment that passed the House this fall with a quarter of the Democrat caucus voting for it--64 Democrats voted for the Stupak-Pitts compromise language. Representative Bart Stupak, the Democratic author, tailored the true compromise amendment on abortion with the principles set forth in the Hyde amendment, which has been the longstanding position of the Congress.

The Hyde amendment simply says we will not use Federal funds for abortion, which is what a vast majority of Americans support. The Hyde amendment has always enjoyed bipartisan support since its inception in 1977, over three decades ago.

What we should have in the health bill is language that applies the Hyde amendment as it already applies to all other federally funded health care programs, including SCHIP, Medicare, Medicaid, Indian health services, veterans health, military health care programs, and the Federal Employees Health Benefits Program. That is what should be in this.

Representative Stupak explained the issue very clearly in an op-ed. He wrote yesterday:

The Capps amendment [which is the basis of the Senate

language] departed from Hyde in several important and

troubling ways: by mandating that at least one plan in the

health insurance exchange provide abortion coverage, by

requiring a minimum $1 monthly charge for all covered

individuals that would go toward paying for abortions and by

allowing individuals receiving federal affordability

credits to purchase health insurance plans that cover

abortion . . . Hyde currently prohibits direct federal

funding of abortion . . . The Stupak amendment is a

continuation of this policy--nothing more, nothing less.

I commend Representative Stupak for his hard work and ability to reach across the aisle to engage his Democratic and Republican colleagues on this issue. A quarter of the Democrats found the Stupak- Pitts compromise worthy of support. But a majority of the American people support keeping the Hyde principles in the Senate health care bill.

I hope we can convince our colleagues in the Senate to follow Mr. Stupak's lead and do the right thing and vote against the motion to proceed. Voting for the motion to proceed is to endorse the Capps language, which is an expansion of Federal taxpayer funding of abortion.

The American people agree with the Stupak compromise, not the phony language in the Senate bill that would federally fund abortions.

The American people agree it is wrong to smuggle radical abortion policy into this health care bill. The American people agree we should not allow funds to flow from a U.S. Treasury account to reimburse for abortion services.

A CNN/Opinion Research Corporation poll showed that more than 6 in 10 Americans favor the Stupak-Pitts prohibition on the use of Federal funds for abortion. A recent study conducted by International Communications Research found that more than two-thirds of Americans are opposed to using Federal dollars to fund abortion. The American people feel this way because they know that forcing taxpayers to fund abortions is fiscally irresponsible and morally indefensible.

Beyond the funding issue, the Senate bill also does not include the codification of the Hyde-Weldon conscience provision. Instead, it replaces real conscience protections with language that violates the human dignity and religious freedom of organizations and religious institutions that have moral objections to participating in abortion.

A provision on page 123 reads:

No individual health care provider or health care facility

may be discriminated against because of a willingness or

unwillingness, if doing so is contrary to the religious or

moral beliefs of the provider or facility, to provide, pay

for, provide coverage of, or refer for abortion.

One other objection for the pro-life community is that there is nothing in the bill that would prevent school-based health clinics from referring for abortion or helping minors make arrangements for abortions without parental knowledge.

The administrators running the Medicaid Program from 1973 to 1976 funded as many as 300,000 abortions per year, until the Hyde amendment was enacted in 1976. In the past, in that period from 1973 to 1977, when there was Federal funding of abortions, the Federal government-- the taxpayers--funded as many as 300,000 abortions per year with taxpayer dollars. That was until the Hyde amendment was enacted in 1976, because the American people despise

doing this. They disagree with that. Whether they are pro-choice or pro-life, they don't want taxpayer dollars to go for this. If they are pro-life, they are saying those are my taxpayer dollars and I am funding this, which I so disagree with doing. This is a beautiful, dignified human life, and my dollars are being used to kill it.

When the Commonwealth of Massachusetts recently passed its State- mandated insurance, Commonwealth Care, without an explicit exclusion of abortion, abortions there were also funded immediately. In fact, according to the Commonwealth Care Web site, abortion is considered covered ``outpatient medical care.'' The Federal Government should not go down this road.

As stated earlier, the President has stated on multiple occasions that it is his goal to lower the incidence of abortion. If that is what he wants to do, if we want to do more than pay lipservice to that reality, we should consider the fact that when Federal funding is not available, fewer abortions occur, or when Federal funding is available, as we have seen in the past, many thousands more occur.

Only the Stupak amendment would lower the incidence of abortion. The current language of the Senate bill would accomplish the opposite and increase abortions. If you are a pro-life Senator, you cannot vote for this bill. This is an expansion. You cannot vote for the procedural vote to go to the bill for the expansion that this will do.

In summary, I will make it clear that the Stupak language is what we need to fix the shell game that would allow public funds to pay for the destruction of innocent human life in the Senate health bill. Unfortunately, language currently within the health bill is a nonstarter and is wrong. It doesn't apply to the longstanding principles of the Hyde amendment. Let's maintain the status quo and not get into the business of publicly funding abortions in America.

I urge my colleagues to think seriously about the precedent being lined out in the health bill if the Senate decides it is going to force the American public to pay for abortions, whether they agree or not.

I urge my colleagues to vote against the motion to proceed to this health care bill. This is not just a procedural vote. It is an enormously important vote because it is the one opportunity for the Senate to stand for life and against taxpayer funding of abortions. Voting in favor of this motion to proceed is a vote against life.

I remind my colleagues, this is the biggest vote on abortion in the Senate in years. Let's not change our current Federal policy to force the American public to pay for government-subsidized abortions, please.

I yield the floor and suggest the absence of a quorum.